2008 Feedback Report Sample - Claims Individual by cap19913

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									                                                                     2008 PHYSICIAN QUALITY REPORTING INITIATIVE FEEDBACK REPORT

Participation in PQRI is at the individual National Provider Identifier level within a Tax ID (TIN/NPI). 2008 PQRI included three claims-based reporting methods, six registry-based reporting methods and two alternate reporting
periods. All Medicare Part B claims submitted with PQRI quality-data codes (QDCs) and all registry data received for services furnished from July 1, 2008 to December 31, 2008 (for the six month reporting period) and for
services furnished from January 1, 2008 to December 31, 2008 (for the twelve month reporting period) were analyzed to determine whether the Eligible Professional (EP) earned a PQRI incentive payment. Each TIN/NPI had
the opportunity to participate in PQRI via multiple reporting methods. Participation is defined as Eligible Professionals (EPs) submitting at least one valid QDC via claims or submitting data via a qualified registry. Valid
submissions are where a QDC is submitted and all measure-eligibility criteria is met (i.e. correct age, gender, diagnosis and CPT). For those NPIs satisfactorily reporting multiple reporting methods, the method associated with
the most advantageous reporting period satisfied was used to determine their PQRI incentive. The methods reported and amounts earned for each TIN/NPI are summarized below. More information regarding the PQRI
program is available on the CMS website, www.cms.hhs.gov/pqri.


Table 1: Earned Incentive Summary for Taxpayer Identification Number (Tax ID)
Sorted by Earned Incentive Yes/No and sub-sorted by NPI Number

Tax ID Name«: John Q. Public Clinic
Tax ID Number: XXXXX6789


                                                                          Distribution of Total Incentive Earned Among Carriers
                                                                               and/or A/B MACs That Processed Payments

Total Tax ID Earned Incentive Amount for NPIs (listed below):                                  Proportion of
                         $14,150.00                            Carrier and/or                 Incentive◘ per         Tax ID Earned Incentive
                                                                 A/B MAC                      Carrier and/or          Amount Under Carrier
                                                              Identification #                   A/B MAC                 and/or A/B MAC
                                                                                  12345                    90.0%              $12,735.00
                                                                                   6789                    10.0%              $1,415.00


NPIs that did not earn an incentive will still appear in the report along with the reason they were not incentive eligible.



                                                                                                                                                                                Total #
                                                                            Earned Incentive●
                                                                                                                                                           Total #            Measures                 Total #
                                                                                                                                                          Measures           Denominator             Measures        Total Estimated   NPI Total Earned
                                                                      Reporting                                                                          with QDCs           Eligible with          Satisfactorily  Allowed Medicare       Incentive
    NPI           NPI Name«              Method of Reporting           Period                      Yes/No                     Rationale                  SubmittedΛ             QDCs~                Reported
                                                                                                                                                                                                               ↨
                                                                                                                                                                                                                   Part B PFS Charges□     Amount*
                                   Individual measure(s) reporting                                                   Sufficient # of measures
1000000002 Smith, Susie            via registry                    6 months                Yes                       reported at 80%                                  10                        8              5           $100,000.00        $1,500.00
                                   Individual measure(s) reporting                                                   Sufficient # of measures
1000000003 Not Available           via registry                    12 months               Yes                       reported at 80%                                    6                       4              3           $133,333.33        $2,000.00
                                                                                                                     Sufficient # of
                                   80% Measures Groups                                                               beneficiaries reported at
1000000004 Not Available           beneficiaries via claims     6 months                   Yes                       80%                                                8                       6              4            $63,333.33         $950.00
                                   80% Measures Groups patients                                                      Sufficient # of patients
1000000006 Not Available           via registry                 12 months                  Yes                       reported at 80%                                    8                       5              4           $166,666.66        $2,500.00

                                   Consecutive Measures Groups                                                       Sufficient # of consecutive
1000000008 Beans, John             patients via registry              6 months             Yes                       patients reported                                  7                       6              4            $53,333.33         $800.00

                                   Consecutive Measures Groups                                                       Sufficient # of consecutive
1000000009 Smithson, Steve         patients via registry              12 months            Yes                       patients reported                                12                      10               9           $166,666.66        $2,500.00
                                   80% Measures Groups patients                                                      Sufficient # of patients
1000000011 Jones, Josie            via registry                    6 months                Yes                       reported at 80%                                    7                       5              4            $93,333.33        $1,400.00
                                   Individual measure(s) reporting                                                   Sufficient # of measures
1000000012 Doe, John               via claims                      12 months               Yes                       reported at 80%                                    6                       4              3            $80,000.00        $1,200.00

                                   Consecutive Measures Groups                                                       Sufficient # of consecutive
1000000013 Not Available           beneficiaries via claims           6 months             Yes                       beneficiaries reported                             9                       8              5            $86,666.66        $1,300.00




                                                                                 Note: The data in this report were created for this sample and are not associated with actual TINs, NPIs, or beneficiaries.
                                                                                                                                                                            Total #
                                                                        Earned Incentive●
                                                                                                                                                       Total #            Measures                 Total #
                                                                                                                                                      Measures           Denominator             Measures        Total Estimated   NPI Total Earned
                                                                 Reporting                                                                           with QDCs           Eligible with          Satisfactorily  Allowed Medicare       Incentive
                                                                                                                                                               Λ                                           ↨
    NPI          NPI Name«             Method of Reporting        Period                       Yes/No                     Rationale                  Submitted              QDCs~                Reported      Part B PFS Charges□     Amount*
                                 80% Measures Groups patients                                                    Insufficient % of patients
1000000001 Not Available         via registry                 6 months                 No                        reported                                           7                       6              4                  N/A              N/A
                                 Individual measure(s) reporting                                                 Insufficient # of measures
1000000005 Not Available         via claims                      12 months             No                        reported at 80%                                    6                       3              2                  N/A              N/A
                                 Individual measure(s) reporting
1000000007 Not Available         via claims                      12 months             No                        Did not pass MAV                                   8                       4              1                  N/A              N/A
                                                                                                                 Insufficient # of
                                 Consecutive Measures Groups                                                     consecutive patients
1000000010 Johnson, John         patients via registry            6 months             No                        reported                                           8                       7              4                  N/A              N/A
                                                                                                                                                                                                                            Total:      $14,150.00

«Name identified by matching the identifier number in the CMS national Provider Enrollment Chain and Ownership System (PECOS) database. If the organization or professional's enrollment record or enrollment changes
have not been processed and established in the national PECOS database as well as at the local Carrier or A/B MAC systems at the time this report was produced, this is indicated by "Not Available". This does not affect the
organization’s or professional’s enrollment status or eligibility for a 2008 PQRI incentive payment, only the system's ability to populate this field in the report.
◘The percentage of the total incentive amount earned by the TIN/NPI combinations, split across carriers based on the proportionate split of the Tax ID’s total estimated allowed Medicare Part B Physician Fee Schedule (PFS)
charges billed across the carriers. (100% of incentive will be distributed by a single carrier if a single carrier processed all claims within the reporting period for the Tax ID).
●An NPI satisfactorily reporting at least one claims-based reporting method or at least one registry-based reporting method and passing the applicable validation process is eligible to receive a PQRI incentive. More
information regarding the incentive calculations is available on the CMS website.
^The number of quality-data codes (QDCs) submitted, but are not necessarily valid. Only valid submissions count towards reporting success. If the reporting method is through measures groups, this field will be populated with
‘N/A’.
~The number of measures for which the TIN/NPI reported at least one valid quality-data code (QDC). If the reporting method is through measures groups, this field will be populated with ‘N/A’.
↨The total number of measures the TIN/NPI reported at a satisfactory rate; satisfactory rate is for ≥ 80% of instances. If the reporting method is through measures groups, this field will be populated with ‘N/A’.
□The total estimated amount of Medicare Part B Physician Fee Schedule (PFS) charges associated with services rendered during the reporting period. The PFS claims included were based on the six or twelve month reporting
period for the method by which the NPI was incentive eligible.
*The amount of the incentive is based on the total estimated allowed Medicare Part B Physician Fee Schedule (PFS) charges for services performed within the length of the reporting period for which a TIN/NPI was eligible. If
N/A, the NPI was not eligible to receive an incentive.
Note: The registry information is based on data calculated and supplied by the 2008 PQRI participating registries.
Note: Your actual payment may vary slightly from the amount listed in the “Total Tax ID Earned Incentive Amount for NPIs” column.




                                                                             Note: The data in this report were created for this sample and are not associated with actual TINs, NPIs, or beneficiaries.
                                                                         2008 PHYSICIAN QUALITY REPORTING INITIATIVE FEEDBACK REPORT

Participation in PQRI is at the individual National Provider Identifier level within a Tax ID (TIN/NPI). 2008 PQRI included three claims-based reporting methods, six registry-based reporting methods and two alternate
reporting periods. All Medicare Part B claims submitted with PQRI quality-data codes (QDCs) and all registry data received for services furnished from July 1, 2008 to December 31, 2008 (for the six month reporting
period) and for services furnished from January 1, 2008 to December 31, 2008 (for the twelve month reporting period) were analyzed to determine whether the Eligible Professional (EP) earned a PQRI incentive payment.
Each TIN/NPI had the opportunity to participate in PQRI via multiple reporting methods. Participation is defined as EPs submitting at least one valid QDC via claims or submitting data via a qualified registry. Valid
submissions are where a quality-data code is submitted and all measure-eligibility is met (i.e. correct age, gender, diagnosis and CPT). For those NPIs satisfactorily reporting by multiple reporting methods, the method
associated with the most advantageous reporting period satisfied was used to determine their PQRI incentive. The results below include: a Participation Summary table listing all of the individual NPI's reporting methods
attempted, an Incentive Detail table listing the reporting method upon which the incentive is based, and a Reporting Detail table listing all of the measures reported by the individual NPI's with the reporting rates. More
information regarding the PQRI program is available on the CMS website, www.cms.hhs.gov/pqri.

Table 2: NPI Reporting Detail
Sorted by Reporting Rate and sub-sorted by Reporting Denominator: Applicable Cases

Tax ID Name«: John Q. Public Clinic
Tax ID Number: XXXXX6789
NPI Number: 1000000012

                                                 Participation Summary
                                                                                Qualified
                                                                      Registry     for               Reporting Period Used
           All Methods Reported                 Reporting Period     Associated Incentive                for Incentive◊◊
Individual measure(s) reporting via claims     12 months            N/A        Yes                   Yes
Individual measure(s) reporting via registry   6 months             ICLOPS     Yes                   No
Individual measure(s) reporting via registry   12 months            STS        No                    N/A

                                                                             Incentive Detail for Individual Measure(s) Reporting via Claims
                                                                          Earned Incentive●
                                                                                                                                           Total #                                               Total #                                 NPI Total
                                                                                                                                        Measures with  Total # Measures                        Measures              Total Estimated      Earned
                                                     Method of       Reporting                                                             QDCs       Denominator Eligible                    Satisfactorily        Allowed Medicare     Incentive
     NPI                 NPI Name«                   Reporting         Period    Yes/No                        Rationale                 Submitted^      with QDCs~                            Reported↨           Part B PFS Charges□   Amount*
                                               Individual
                                               measure(s) reporting                                  Sufficient # of measures
  1000000012 Doe, John                         via claims           12 months  Yes                   reported at 80%                                       6                              4                    3            $80,000.00     $1,200.00

                                                                                                   Reporting Detail

                                                                                                            Reporting                     Numerator:
                                                                                      Measure              Denominator:                   Valid QDCs                                           Measure Validation Clinical Focus
  Measure #                       Measure Title (Measure #)▲                           Type■             Applicable Casesℓ                Reported◊               Reporting Rate»                           Area‡
                Chronic Obstructive Pulmonary Disease (COPD): Spirometry           Patient-
     #51        Evaluation (#51)                                                   Process                                      200                     180                        90.0% COPD Care
                Stroke and Stroke Rehabilitation: Discharged on Antiplatelet
     #32        Therapy (#32)                                                      Episode                                        90                      74                       82.2% Stroke Discharge
                Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator       Patient-
     #52        Therapy (#52)                                                      Process                                      500                     400                        80.0% COPD Care
                Stroke and Stroke Rehabilitation: Anticoagulant Therapy
     #33        Prescribed for Atrial Fibrillation at Discharge (#33)              Episode                                        70                      42                       60.0% Stroke Discharge


«Name identified by matching the identifier number in the CMS national Provider Enrollment Chain and Ownership System (PECOS) database. If the organization or professional's enrollment record or enrollment changes
have not been processed and established in the national PECOS database as well as at the local Carrier or A/B MAC systems at the time this report was produced, this is indicated by "Not Available". This does not affect
the organization’s or professional’s enrollment status or eligibility for a 2008 PQRI incentive payment, only the system's ability to populate this field in the report.




                                                                             Note: The data in this report were created for this sample and are not associated with actual TINs, NPIs, or beneficiaries.
◊◊The method of reporting deemed most advantageous will be indicated with a “Yes”. If the NPI did not qualify for incentive through any reporting methods, the reporting method that was most advantageous would be
populated with N/A.
●An NPI satisfactorily reporting at least one claims-based reporting method or at least one registry-based reporting method and passing the applicable validation process is eligible to receive a PQRI incentive. More
information regarding the incentive calculations is available on the CMS website.
^The number of quality-data codes (QDCs) submitted, but are not necessarily valid. These instances do not count towards reporting success.
~The number of measures for which the TIN/NPI reported a valid quality-data code (QDC).
↨The total number of measures the TIN/NPI reported at a satisfactory rate; satisfactory rate is for ≥ 80% of instances.
□The total estimated amount of Medicare Part B Physician Fee Schedule (PFS) charges associated with services rendered during the reporting period. The PFS claims included were based on the six or twelve month
reporting period for the method by which the NPI was incentive eligible.

*The amount of the incentive is based on the total estimated allowed Medicare Part B Physician Fee Schedule (PFS) charges processed within the length of the longest reporting period satisfied by the eligible professional.
▲Reference number for each measure, according to the 2008 PQRI Quality Measures Specifications document on the CMS PQRI website.
■The analytic category for each measure that determines how the measure will be calculated for PQRI. Measure types can be found in the PQRI Feedback Report User Guide.
ℓThe number of instances the TIN/NPI was eligible to report the measure. The number of eligible denominator instances found in claims.
◊The number of reporting instances where the quality-data codes (QDCs) submitted met the measure specific reporting criteria.
»A satisfactorily-reported measure has a reporting rate of 80% or greater.
‡Eligible professionals may find that they have opportunities to report measures in areas that are clinically-related to measures they have chosen to report. The clinical focus area, according to the measure-applicability
validation (MAV) process, for each measure is indicated. Please note that some measures may be generally applicable and are not part of a clinical focus area. A detailed description of the MAV process is available on the
CMS website.




                                                                            Note: The data in this report were created for this sample and are not associated with actual TINs, NPIs, or beneficiaries.
                                 2008 PHYSICIAN QUALITY REPORTING INITIATIVE FEEDBACK REPORT

Participation in PQRI is at the individual National Provider Identifier level within a Tax ID (TIN/NPI). 2008 PQRI included three claims-based reporting methods, six registry-
based reporting methods and two alternate reporting periods. Each TIN/NPI had the opportunity to participate in PQRI via multiple reporting methods. The individual NPI’s
quality-data code (QDC) submission error results are below. There will be one NPI detail report for each TIN/NPI participating in PQRI. Participation is defined as Eligible
Professionals (EPs) submitting at least one valid QDC via claims or submitting data via a qualified registry. More information regarding the PQRI program is available on the
CMS website, www.cms.hhs.gov/pqri.

Table 3: NPI QDC Submission Error Detail
Sorted by Measure

                                                     Incorrect CPT, Incorrect DX, Incorrect CPT and DX, Only QDC on Claim, and Only QDC and Incorrect DX are all mutually
                                                     exclusive. If there is an incorrect CPT code and also an incorrect diagnosis, it will only fall into the "Both Incorrect CPT and
                                                     DX" cell for that measure and will not fall into the other two cells.

Tax ID Name«: John Q. Public Clinic
NPI Name«: Doe, John
NPI Number: 1000000012
Method of Reporting: Individual measure(s) reporting via claims for 12 months


                                                                                          QDC Submission Error Detail
                                                                               QDC Occurrences                                                               QDC Exceptions (Denominator Mismatches)

                                                                                    Numerator: % of Valid                                            Only
                                                       Measure       Actual #       Valid QDCs  QDCs                                               Incorrect Only Incorrect               Both Incorrect               Only QDC on Only QDC and
  Measure #        Measure Title (Measure #)▲           Type■       ReportedΩ       Reported◊ Accepted₪ Gender                          Age          CPT           DX                     CPT and DX╒                 Claim (no CPT)⌂ Incorrect DXξ
                  Stroke and Stroke
                  Rehabilitation: Discharged on
      #32         Antiplatelet Therapy (#32)         Episode                   99                 74           74.7%              0            0             13                      5                            4                1              2
                  Stroke and Stroke
                  Rehabilitation: Anticoagulant
                  Therapy Prescribed for Atrial
      #33         Fibrillation at Discharge (#33)    Episode                   54                 42           77.8%              0            0               8                     2                            0                2              0
                  Chronic Obstructive Pulmonary
                  Disease (COPD): Spirometry         Patient-
      #51         Evaluation (#51)                   Process                 210                 180           85.7%              0            0             21                      2                            7                0              0
                  Chronic Obstructive Pulmonary
                  Disease (COPD): Bronchodilator     Patient-
      #52         Therapy (#52)                      Process                 410                 400           97.6%              0            0               3                     7                            0                0              0
                  Asthma: Pharmacologic Therapy      Patient-
      #53         (#53)                              Process                   50                   0           0.0%              0           25             12                    32                             4                2              0
                                                     Patient-
      #64         Asthma Assessment (#64)            Process                   25                   0           0.0%              0           15             14                      2                            8                0              1

«Name identified by matching the identifier number in the CMS national Provider Enrollment Chain and Ownership System (PECOS) database. If the organization or professional's enrollment
record or enrollment changes have not been processed and established in the national PECOS database as well as at the local Carrier or A/B MAC systems at the time this report was produced,
this is indicated by "Not Available". This does not affect the organization’s or professional’s enrollment status or eligibility for a 2008 PQRI incentive payment, only the system's ability to populate
this field in the report.
ΩNumber of quality-data code (QDC) submissions for a measure whether or not the QDC submission was valid and appropriate.
◊Number of valid and appropriate quality-data code (QDC) submissions for a measure.
₪The percentage of reported quality-data codes (QDCs) that were valid.
╒Number of invalid quality-data code (QDC) submissions resulting from a combination of incorrect CPT code and incorrect diagnosis code (DX).
⌂Number of invalid quality-data code (QDC) submissions due to a missing qualifying denominator code since all lines were QDCs.
ξNumber of invalid QDC submissions due to a missing qualifying denominator code since all lines were quality-data codes (QDCs) and the diagnosis codes (DXs) were incorrect.
Note: A QDC submission attempt may be counted for age, gender, and one of the following: Incorrect CPT, Incorrect DX, Both Incorrect CPT and DX, Only QDC on Claim (no
CPT), and Only QDC and Incorrect DX (i.e. a submission attempt may be counted for age, gender, and incorrect DX).




                                                                                    Note: The data in this report were created for this sample and are not associated with actual TINs, NPIs, or beneficiaries.
                                                        2008 PHYSICIAN QUALITY REPORTING INITIATIVE FEEDBACK REPORT

Participation in PQRI is at the individual National Provider Identifier level within a Tax ID (TIN/NPI). 2008 PQRI included three claims-based reporting methods, six registry-based reporting methods and two
alternate reporting periods. All Medicare Part B claims submitted with PQRI quality-data codes (QDCs) and all registry data received for services furnished from July 1, 2008 to December 31, 2008 (for the
six month reporting period) and for services furnished from January 1, 2008 to December 31, 2008 (for the twelve month reporting period) were analyzed to determine whether the eligible professional (EP)
earned a PQRI incentive payment. Each TIN/NPI had the opportunity to participate in PQRI via multiple reporting methods. Participation is defined as EPs submitting at least one valid QDC via claims or
submitting data via a qualified registry. For those NPIs satisfactorily reporting multiple reporting methods, the method associated with the most advantageous reporting period satisfied was used to
determine their PQRI incentive. There will be one NPI performance detail report for each TIN/NPI participating in PQRI. More information regarding the PQRI program is available on the CMS website,
www.cms.hhs.gov/pqri.

Table 4: NPI Performance Detail
Sorted by Clinical Performance Rate
                                              # Numerator Eligible Reporting Instances = 1P + 2P + 3P + Other + Clinical Performance Denominator
                                              Clinical Performance Denominator = Clinical Performance Numerator + QDC Reported + Insufficient QDCs

Tax ID Name«: John Q. Public Clinic
NPI Name«: Doe, John
NPI Number: 1000000012
Method of Reporting: Individual measure(s) reporting via claims for 12 months

                                                                                              Performance Information
                                                                  Numerator Eligible Instances                                           Clinical Performance Not       National Comparison for
                                                                          Excluded                    Clinical      Clinical                        Met                     Performance◊◊◊
                                               Numerator:                                           Performance Performance    Clinical                Insufficient
                                               Valid QDCs      Medical Patient System               Denominator Numerator    Performance    QDC           QDC        25th        50th        75th
                                                                                                                                                                   ℓ
Measure #     Measure Title (Measure #)▲       Reported◊        (1P)    (2P)      (3P)    Other««        ◘◘          Met║      Rate□□□   Reported¤ Information Percentile Percentile      Percentile
            Chronic Obstructive Pulmonary
            Disease (COPD): Spirometry
    #51     Evaluation (#51)                            180          53       15         12             0                100                   80              80.0%                20                    0      23.2%   51.0%   84.3%
            Stroke and Stroke
            Rehabilitation: Anticoagulant
            Therapy Prescribed for Atrial
    #33     Fibrillation at Discharge (#33)               42          6        4           0            0                  32                  18              56.3%                14                    0      74.0%   81.4%   90.8%
            Chronic Obstructive Pulmonary
            Disease (COPD):
    #52     Bronchodilator Therapy (#52)                400           7        3           1           14                375                 175               46.7%              102                   98       0.0%    34.2%   72.1%
            Stroke and Stroke
            Rehabilitation: Discharged on
    #32     Antiplatelet Therapy (#32)                    74         18        2           0            0                  54                  15              27.8%                39                    0      34.3%   52.8%   94.7%

«Name identified by matching the identifier number in the CMS national Provider Enrollment Chain and Ownership System (PECOS) database. If the organization or professional's enrollment record or
enrollment changes have not been processed and established in the national PECOS database as well as at the local Carrier or A/B MAC systems at the time this report was produced, this is indicated by
"Not Available". This does not affect the organization’s or professional’s enrollment status or eligibility for a 2008 PQRI incentive payment, only the system's ability to populate this field in the report.
▲Reference number for each measure, according to the 2008 PQRI Quality Measures Specifications document on the CMS PQRI website.
◊The number of reporting instances where the quality-data codes (QDCs) submitted met the measure specific reporting criteria.
««Includes instances where a CPT II code, G-code, or 8P modifier is used as a performance exclusion for the measure.
◘◘The performance denominator is determined by subtracting the number of eligible instances excluded from the numerator eligible reporting instances. Valid reasons for exclusions may apply and are
specific to each measure. The 2008 PQRI Quality Measures Specifications document is available on the CMS PQRI website.
║The number of instances the NPI within the Tax ID submitted the appropriate quality-data code(s) (QDCs) satisfactorily meeting the performance requirements for the measure.
□□□The Clinical Performance Rate is calculated by dividing the Clinical Performance Numerator by the Clinical Performance Denominator.
¤Includes instances where a CPT II code with an 8P modifier or G-code is used to indicate the quality action was not provided for a reason not otherwise specified.
ℓThe number of instances where clinical performance was not met due to insufficient quality-data code (QDC) information/numerator coding not complete for the measure from the TIN/NPI combination (e.g.
two numerator codes are necessary for the measure, only one was submitted; inappropriate CPT II modifier submitted for the measure).
◊◊◊The National Comparison for Performance includes performance information for all TIN/NPI combinations submitting at least one quality-data code (QDC) for the measure. The 25th percentile indicates
that 25% of the TIN/NPI combinations participating nationally are performing at or below this rate, the 50th percentile indicates that 50% of the TIN/NPI combinations participating nationally are performing
at or below this rate, and the 75th percentile indicates that 75% of the TIN/NPI combinations participating nationally are performing at or below this rate.
Note: For the Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus (#1) measure, a lower performance rate indicates better performance.
Note: The registry information is based on data aggregated across 2008 PQRI participating registries.




                                                                                   Note: The data in this report were created for this sample and are not associated with actual TINs, NPIs, or beneficiaries.

								
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